5 and 24 November 2015
During a routine inspection
We inspected RNID Action on Hearing Loss North East Outreach on 5 and 24 November 2015. This was an announced inspection. We informed the registered provider at short notice we would be visiting to inspect. We did this because we wanted the registered manager to be present at the service on the day of the inspection to provide us with the information we needed.
The service is registered to provide personal care to people living in their own homes. The service can provide care and support to people with sensory impairment, older people, people with mental health conditions, people with a learning disability or autistic spectrum disorders, physical disability or younger adults. At the time of the inspection only one person was receiving personal care from the service.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The quality assurance system in place to monitor the safety and quality of the service was not effective in highlighting areas requiring improvement.
Team meetings had not taken place at the frequency the registered manager told us they should have done.
Staff told us the registered manager was supportive. However staff had not received regular supervision. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. The registered manager told us they would be completed by the end of January 2016 and a plan for keeping up to date would be put in place
The majority of staff were up to date with training. Staff told us they had received training which had provided them with the knowledge and skills to provide care and support. Outstanding training had been arranged to be completed.
Recruitment and selection procedures were in place and we saw checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. We saw gaps in employment had not been fully explored or recorded in staff files. We found not all recruitment documents were held locally. The registered manager confirmed following the inspection they were now held locally.
Procedures were in place for the safe management of medicines. Staff at the time of the inspection did not administer medicines to anyone. A person they supported self administered their own medicines. The risks associated with this were not fully documented in their care file. A completed risk assessment was provided following the inspection.
The risk assessments in place regarding the service provision were not appropriate for people being supported in their own home and they were more relevant to a residential service. The registered manager told us these would be reviewed in December 2015.
There were risk assessments in place for people who used the service. The risk assessments and care plans had been reviewed and updated on a regular basis. Risk assessments covered areas such as mobility and falls. This meant staff had the written guidance they needed to help people to remain safe.
The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. The training matrix we saw showed all the team had been on training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. We saw MCA decisions and best interest decisions were not recorded. Following the inspection the registered manager provided evidence this had been completed.
Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. We saw not all hazards relating to the person support were built into the care plans.
There were enough staff employed to provide support and ensure people’s needs were met. People who were supported confirmed staff were punctual and they liked their support staff.
There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.
People told us staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.
People had a wide variety of activities they enjoyed, some were accessed independently and others with staff support. There was a staff matching tool used so people could identify which staff they wanted to support them on particular activities.
People were supported to cook a varied diet, grow some of their own food and develop their skills in cookery.
Staff at the service worked with other healthcare professionals to support people. Staff worked and communicated with professionals interpreting sign language for the person where they were asked to do so by the person.
The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident staff would respond and take action to support them.
Staff told us the service had an open, inclusive and positive culture and they found the registered manager approachable.
There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.